


LIBRARY OF CONGRESS, 



RTTZT 

Shelf ->LlL 



UNITED STATES OF AMERICA. 



■ 






THE 



SYSTEMIC FUNCTIONS 



AND THEIR 



RECIPROCAL INFLUENCE 



IN 



DISEASE. 




//■nay 



f 



Being Preliminary to a study of Pharmaco-Dynamics. 



v/ 



A. W. WOODWARD, M. D., 

Professor of Materia Medica and Clinical Therapeutics, 
Chicago Homoeopathic Medical College. 



PUBLISHED FOR THE CLASS. 



l8 93 . 



V 5 fv 



CO 






*v 



Entered according to Act of Congress, in the year 189 

By ALFRED W. WOODWARD, 

In the office of the Librarian at Washington, 1). C. 



E. CRANDALL, 
TP INTER. 



INTRODUCTION. 



The fundamental difference between physicians of the Old 
school and the New, is to be found in their method of observing 
disease as a therapeutic problem. An Old school physician 
in charge of a number of cases of croupous pneumonia, sees 
little or no difference between one and another, for the physi- 
cal signs, the cough, pain, dyspnoea and other local symptoms, 
are practically the same ; consequently, being guided by these 
pathological indications, his treatment will be alike in all cases. 
Should a serious complication arise in any case, he will treat 
it independently of the disease. 

The New school physician considers his cases differently. 
He sees these points of similarity, but also finds that the 
collateral phenomena, headache, delirium, pains in back or 
limbs, vomiting or diarrhoea, differences of temperature, car- 
diac tone, etc., show considerable variation ; consequently 
he distinguishes one case from another by the presence or ab- 
sence of these concomitants. He then chooses his remedy for 
each case as a unit. 

Hahnemann was the first teacher who recognized the im- 
portance of the collateral symptoms as a means of differentia- 
tion between cases of the same class, and believing them to be 
most essential as therapeutic indications, he advanced the 
doctrine that "together with the exciting cause or local lesion 
the totality of symptoms presented by a case, are the only 
reliable guide for the selection of a remedy." Organon §7; §18. 

As a general proposition this doctrine must be accepted, 
for if a patient has other symptoms besides the local, the 
disease to that extent is constitutional, and if each patient 
with a hepatized lung presents a different group of functional 
derangements in other parts, then each case, constitutionally 



INTRODUCTION. 



considered is a different disease, though the lesion may be the 
same in all cases. 

Assuming, therefore, that the cure of disease depends pri- 
marily upon a correct estimate of all its phenomena, the ques- 
tion arises : How shall the symptoms of a case be interpreted, 
literally, or otherwise? Because the special character of the 
local symptoms are important as a means of diagnosis, Hah° 
nemann concluded that the reflex or sympathetic phemomena 
were equally significant. Hence he taught that "the totality 
of symptoms per se constituted the disease," and the curative 
remedy was one that was capable of producing a group of 
symptoms that was similar in each detail. Organon §8; §17. 

Upon this basis the entire system of homoeopathic thera- 
peutics has been built. Drug provings have been made on 
the supposition that each medicine would produce many 
individual symptoms that were peculiar to itself, and the 
similarity existing between the action of a drug and the symp- 
toms of diseases could be easily traced. Experience, how- 
ever, has proved otherwise. More than seven hundred medi- 
cines have been proved, their symptoms filling upwards of six 
thousand closely printed pages. Upon a critical comparison 
of the pathogeneses of these drugs it will be found that not one 
symptom in ten is peculiar to one drug alone, that fully 
ninety-five per cent, are common to two or more different 
medicines. This being true, while the remedy required in a 
given case may be found by tracing its various symptoms 
through a repertory, the labor and time required in so doing 
makes this method as a rule impracticable. As a consequence 
many physicians at the present time are striving to make the 
few symptoms which are peculiar to each drug, a basis for a 
general therapeutics. This being the condition of our Materia 
Medica, and the last recourse having failed to give satisfaction, 
it becomes apparent that the doctrine of " Similia" is in 
danger of being abandoned, unless the symptoms of disease, 
and the symptoms produced by drugs can be given a wider 
signification than they now possess. 



INTRODUCTION. V 

The object of this introduction is to show briefly that the 
guiding indications for the treatment of disease are not to be 
found in the special symptoms of the case, as taught by Hah- 
nemann, but in the group of physiological derangements 
which are indicated thereby. "With this end in view, a new 
study of disease is proposed, the salient points of which will 
be seen in the following cases : 

Scarlet Fever. — Ella G., aged 6, having been put to bed as well 
as usual, wakened in the night with a flushed face, high fever and 
sore throat. When seen by the physician her skin was very hot, 
pulse 130, hard and full, temperature 103 , throat red and painful 
when swallowing ; nervous symptoms were not apparent. On the 
second day the rash was developing; pulse 150 and weaker, tem- 
perature 104 5 °, sub maxillary glands much swollen ; she now showed 
some restlessness and complained of headache. On the third day it 
was reported that her kidneys had been very active for twenty-four 
hours ; her pulse was 150, weak and occasionally intermitting, tem- 
perature 103 5 °, rash and throat symptoms the same; that evening 
she complained of dyspnoea and some pain in her chest ; examina- 
tion gave friction sounds in pericardium ; these symptoms were 
attended by thirst and occasional nausea, restlessness continued, 
the calls to urinate were frequent but scant. On the morning of the 
fourth day the eruption was fading and there was intense itching of 
the skin ; the cardiac symptoms were no worse, temperature 103 , 
pulse 140 ; urination occurred about once in two hours ; examina- 
tion proved quantity of urine reduced but no albumin ; there was 
some debility, the nausea had abated, thirst continued. On the fifth 
day a slight valvular murmur could be heard, though the pain about 
the heart was less severe ; other symptoms remained about the same, 
temperature 102 , debility continued to increase with some pains in 
abdomen. * * * Desquamation began on the eighth day ; the 
patient felt much improved, though the pulse continued high ; she 
had a voracious appetite and urinated but twice in twenty-four 
hours. On the twelfth day oedema became apparent, and rapidly 
increased. On the thirteenth day pulse was 136 and weak, tempera- 
ture ioo° she felt weak and wanted to lie down ; the urine was 
scant, high colored and upon analysis showed considerable albumin 
but no casts ; in the evening she had several copious stools of watery- 
character ; this continued at intervals for three days with relief of 
anasarca; a rapid convalescence followed. 



Typhoid Fever — Wilson K., aged 55, had complained for two 
weeks of loss of appetite and debility ; these symptoms gradually 
increased ; finally a headache developed, followed by a sleepless 
night ; on the day following a chill occurred, this was succeeded by 
fever, his tongue, which had been coated, became dry ; he com- 
plained of thirst and aching in the back and limbs, the headache 
was much increased and he was sure he was going to die, his face 
was but little flushed, pulse 86, temperature roi° other functions 
were about normal. * * * On the fifth day he complained 



VI INTRODUCTION. 

of some pain and tenderness in abdomen, especially in the ccecal re- 
gion ; he was more restless and had tiresome dreams at night; 
pulse 90, temperature 101 40 . * - * On the eighth day diarrhoea 
developed, this was attended by restlessness, some jactitation and 
delirium at night ; pulse 96, temperature 102 , he had a slight bron- 
chial cough at intervals; his face was more flushed, urine high 
colored but otherwise normal. * * - : " On the twelfth day a few 
roseola spots were found on the abdomen, his stools occurred about 
once in three hours, other symptoms much the same. * * * 
Diarrhoea continued until the sixteenth day. * " x " * On the twen- 
ty-first the temperature morning and evening was normal ; it had 
not risen above 102 during his illness. * * * Convalescence 
was slow ; three weeks later his appetite was voracious and his 
bowels obstinately constipated ; he continued weak and com- 
plained that his joints were stiff, it was also noticable that his dis- 
position, which formerly had been buoyant and happy, had now be- 
come gloomy and depressed. 



Analyzing these cases after the prodromal stage, there 
were in each at least five distinct groups of symptoms as 
shown by the following tables : 



THE SCARLET FEVER. 



Si 



Ra>h develo- 
ping. Sub 
maxillary 
glands swol- 
len, tempera- 
ture io^°. 



Pulse 130 
hard and full. 



Throat red Some restless- 
and painful. ness. 



Polyuria. 



2nd Rash fully de- 
Staoe veloped, tem- 
perature 104a 



Pulse weaker. Throat the 

Dyspnoea. same, thirst. 
Pericarditis nausea, 

beginning. 



Increased 

restlessness. 



Frequent and 
scant urine. 



Rash fading, 
3RD intense itch- 
StaGE ing, tempera- 
ture lO;fi' J 



4TH 

Stage 



5 TH 

Stagk 



Desquamation 



Pulse 150, Throat better, 
intermittent. thirst and 

Endocarditis pain in abdo- 
beginning. men. 



Pulse high. Keen appetite. 



Pulse 136. Copious dia- 

irca. Weak.irregu- rrh'L-a. 

lar. Hydremia. 



Debility. 



Strength re- 
turning. 



Debility re 
turned. 



Frequent and 

scant urine. 

No albumin. 



Infrequent 
scant urine. 
Nephritis be- 
ginning. 

Urine scant 
albuminous. 



INTRODUCTION. 

THE TYPHOID FEVER. 



Stage 



Tongue dry 
ind coated. 



Debility and 

aching in 

back and 

limbs. 



Pain and ten- Aching con- 
tinues with 
restlessness. 



Stage abdomen. 



Severe head- Chill and 

ache and men- ;fever. Little Pulse 86. 

tal depression, flush. Tem- 
perature 101°. 



Stage Diarrhoea. 



] actuation. 



Dreams. 



Temperature Pulse QO 

IOl4°. 



Restlessness 

continues with - .- . . * * ce , m ° re Pulse 96. 

Delirium. flushed, lem Cough at 

perature 102° intervals. 



4TH 

Stage 



Ditto. 



Ditto. 



Ditto. 



Roseola spots 



Ditto. 



• Voracious ap- 

5TH petite consti- 
pation. 



Stage 



Weakness and Morose and 
stiffjoints. gloomy. 



Reviewing the first case, the character of the skin symp- 
toms should be compared from the beginning to the end; 
also the circulatory, gastric, etc. 

The same should be done in the second case. Note the 
variety of symptoms developed in the alimentary canal, also 
in the spinal, mental and other centers. 

Again considering the locality of the symptoms : In the 
first case the circulatory were shown primarily by arterial 
excitement. Then appeared an incipient pericarditis followed 
by endo-carditis. The primary sore throat was succeeded by 
gastric irritation and then by diarrhcea. Polyuria was fol- 
lowed by scant urines and later by albuminuria. 

In the second case, at the beginning there was a coated 
tongue and thirst, followed by abdominal tenderness, and later 
by diarrhoea. Also backache, followed by restlessness, debil- 
ity, and finally stiffjoints. 

Thus it appears in these, and it is equally true in all 
acute diseases, that the symptoms are constantly changing, 
both in character and location. This is a fact of great signif- 



NTRODUCTION 



icance. considered either pathologically or therapeutically. In 
the first place, this quality of variableness means that the 
particular symptoms in themselves do not constitute the dis- 
ease as claimed in the Organon §8: §17. for if that doctrine 
were true, these cases presented as many different diseases 
as there were different groups of symptoms. On the con- 
trary, there existed but one patliological condition in each, 
which exhibited its various phazes through these symptoms, 
hence they served only to determine the nature and progress 
of the affection. 

To discover the unity of the disease it was necessary to 
look beneath the symptoms to their source. This revealed 
one unchangable characteristic in each, namely : the same 
group of systemic functions were involved from first to last 
and they preserved the same relative importance, one with 
another, to the end. This was established by the order of de- 
velopment of the disease. In the first case the primary 
symptom was manifested upon the skin. Whether the disease 
was to be a cutaneous affection or not. this event determined 
the location of the most important symptoms throughout the 
case. The next disturbance was shown by the circulatory 
organs, hence they were of second importance ; while the 
symptoms of the alimentary canal were more significant than 
those of the motor or renal organs. 

In the second case, the primary symptoms of the alimen- 
tary canal were most significant, whether the disease proved 
to be an enteric affection or otherwise ; next in importance 
were phenomena arising from the motor centres, while the 
mental were of more consequence than the cutaneous or cir- 
culatory disturbances. 

The characteristic features of these cases being thus man- 
ifested, the question arises : If complications had ensued with 
new and severe symptoms, would they not constitute a new 
and independent disease? In the first case, if a pericarditis. 
endo carditis, tonsilitis, gastro enteritis, rheumatism or ne- 
phritis had occurred, they would have been legitimate sequelae 



INTRODUCTION. 



of the disease, for the functions which these organs represent 
were originally involved. Suppose a nephritis had developed, 
though its symptoms would have been most severe and most 
serious, they would have been of subordinate importance to 
the cutaneous, circulatory, gastric and spinal phenomena at- 
tending, because renal symptoms were secondary and conse- 
quent upon the original disease and the preceding derange- 
ments. If however a cerebritis had occurred, it would have 
been an independent affection, for the mental function had 
not been originally involved. 

In the second case sequelae might have risen in the 
spinal centres, shown by paralysis, etc., or in the brain, indi- 
cated by mental failure etc., or in the sensory organs, de- 
veloping blindness, deafness, etc., or in the respiratory and 
circulatory organs, shown by pneumonia, heart lesions, anae- 
mia, etc. If one of these had occurred, it would not have 
altered the elements of the case, the preceding disorders 
which characterized the fever would have continued to govern. 
But if renal or sexual derangements had risen, they would 
have been independent disorders, for these functions were not 
involved by the primary disease. 

Passing to the therapeutic indications presented by these 
cases, it is taught that whenever the symptoms change, the 
remedy should be changed, especially when they show that 
different organs have become involved. 

Organically considered, there was little resemblance be- 
tween the first and third stage of either case. Apparently 
they were different affections, hence if this rule applies, one 
of two deductions must follow, viz : Either that five different 
remedies are required to conduct a normal case to its conclu- 
sion ; or, that the symptoms themselves are not the correct 
indications for treatment. 

The first alternative being irrational, the second must be 
accepted, consequently the unchangable indications for treat- 
ment must be found in the group of physiological derange- 



X INTRODUCTION. 

ments, which, manifested by various symptoms, are present 
from the beginning to the end of the case. 

To recoginze each member of a group by means of symp- 
toms that are constantly changing, will continue to be diffi- 
cult, until the various organs and tissues which belong to each 
systemic function are classified. This accomplished, the 
symptoms arising from the organs associated in each function^ 
can be given a common interpretation, and the continuity of 
the case readily be recognized. 

From the foregoing observations it may be assumed : 

First — that whenever a local lesion results from con. 
stitutional disorders, the peculiarities of the case cannot be 
discovered without an intimate knowledge of systemic physi- 
ology. 

Second — that whenever a local lesion becomes the cause 
of constitutional derangements, the individuality of the case 
must be sought in the group of symptoms produced by the 
systemic functions involved thereby. 

Third — that it is only when disease is strictly a local 
affection, having no preceding or concomitant derangements, 
that a knowledge of the physiological action of the affected 
part will suffice for its explanation ; and only then can the 
symptoms arising therefrom be accepted literally as in- 
dications for treatment. 



THE SYSTEMIC FUNCTIONS. 



The functions which, are essential to human life are prob- 
ably eight in number, viz : 

The function of general Nutrition. 
The function of general Respiration. 
The function of general Circulation. 
The function of general Excretion. 
The function of general Reproduction. 
The function of general Motion. 
The function of general Sensation. 
The function of general Intelligence. 

The Nutritive Function is performed by the Digestive 
apparatus which includes the Lips, Mouth, Tongue, Teeth 
Parotid glands, Maxillary glands, Lingual and Solitary glands, 
Fauces, (Esophagus, Stomach, Liver, Mesentery, Peritoneum, 
Duodenum, Jejunum, Ileum, Vermiform appendix, Pancreas, 
Colon, Rectum and Anus, with the Mucous membrane lining 
the alimentary canal, except those portions covering the palate 
and upper surface of the tongue, and the rectum between the 
internal and external sphincters ; their common purpose being 
to suitably prepare nourishment for the economy. 

The Respieatory Function is performed by the res- 
piratory apparatus and the mucous membrane lining the air 
passages. It includes that membrane lining the Nares, Lach- 
rymal ducts, Frontal sinuses, Antrums, Eustachian tubes and 
middle ear, the Epiglottis, Larynx, Bronchia and Air cells, 
also the Trachea, Lungs, Pleura, Diaphragm, Bronchial 



2 THE SYSTEMIC FUNCTIONS. 

glands and Mediastinum ; their common purpose being to sup- 
ply oxygen, and eliminate gaseous products from the blood. 

The Circulatory Function is performed bv an appa- 
ratus which includes the Blood, the Heart, Arteries Capilla- 
ries, Veins, the Thoracic Duct and Lymphatics, also the 
Pericardium, Thyroid and Lymphatic Glands, Spleen and 
Supra renal bodies ; their double purpose being to act as a 
reservoir of supplies and a receptacle of waste matters for the 
economy. 

The Excretory Function is performed by the Urinary 
apparatus, consisting of the Kidneys, Ureters, Bladder, Sphinc- 
ter vesicae and Urethra ; their common purpose being to 
eliminate waste matters from the blood. 

The Reproductive Function is performed by the 
Genital apparatus, including the Ovaries, Fallopian tubes, 
L T terus, Vagina and its glands, the Mammary glands, the 
Clitoris. Also the Testicles, Epididymis, Vas deferens, Sper- 
matic cords, Prostate and lesser glands, and Penis ; their 
common purpose being to procreate the species. 

The Motor Function is performed by the spinal ap- 
paratus, consisting of the Bones, Muscles, Ligaments, Ten 
dons, Cartilages, Fibrous and Connective tissue, Synovial, 
Meningeal and Periosteal membranes. Also the Motor or 
efferent nerves both general and special, together with the 
Musculo-sensory nerve of each part ; the Anterior and Lateral 
columns of the Spinal cord and Medulla oblongata, the Corpus 
striatum, Pons varolii and Cerebellum, including also the In- 
hibitory centres of involuntary motion ; the common purpose 
of these various parts being to facilitate and co-ordinate the 
various movements necessary to living organisms. 

The Sensory Function is performed by the cutaneous 
apparatus, including the Sensory or Afferent nerves distributed 
to the surface of the body. This apparatus consists of the 



THE SYSTEMIC FUNCTIONS. 



Skin, Hair, IS ails, Superficial blood vessels and glands, with 
the sub cutaneous adipose and areolar tissue. Also : 

C Conjunctiva lachrymal glands, 

cornea, iris, lenses, humors, 

m . „ . . L , retina and optic nerve, with 

The Eye and its attachments.^ ^ ^ Q ^ ^ mugcleS; and 

motor nerves and blood vessels 
distributed thereto. 

f External meatus, tympanum? 

„..,., -,, J ossiculi, and reflexions of muc- 

The Auditory parts of the ear.^ ous membrane which distri . 

l^butethe auditory nerve. 



The Olfactory parts of the 
nose. 



fThe squamous mucous mem- 
j brane covering the septum and 
j turbinated bones, which distri- 
butes the olfactory nerve. 



The Gustatory parts of the 

mouth, and sensitive lining 

of anus. 



f That portion of the mucous 
I membrane covering the 
tongue and palate which distri- 
butes the gustatory nerve, also 
a portion of the mucous mem- 
brane lining the anal fissure 
between the external and in- 
^ternal sphincters. 



The Sensitive parts of the 
skin. 



Containing the tactile and pain 
corpuscles of the afferent nerves, 
and the peripheral branches of 
<[ the sympathetic, by which are 
recognized cold,heat and damp- 
ness ; also the motor nerves 
distributed to the cutis vera. 



Also the Posterior and Lateral columns of the spinal cord 
and Medulla oblongata, the Optic thalami, including probably 
the vaso motor and heat centres, the Pons varolii, and the 
Cerebellum ; the chief purpose of these various parts being to 
convey to the Sensorium every external impression. 



4 THE SYSTEMIC FUNCTIONS. 

Judging from analogy, as the base of the brain unites the 
sensory and motor tracts, it corresponds to the brain of the 
lower forms of life, hence it may be presumed that the com- 
bined purpose of these organs is the same in man as in the 
brute creation, and that together they form the sensorium. If 
so, in some measure this must be the source of Consciousness, 
the Instinctive impulses, Appetites and Passions, as well as 
Perception and Volition, attributes that are common to all the 
Vertebrata in a greater or less degree. 

The Intellectual Function is performed by the Men- 
tal apparatus, consisting of the Cerebrum, namely: The First, 
Second, and Third frontal convolutions, the Ascending frontal, 
the Ascending parietal, Superior parietal, Superior marginal, 
the Angular, the First, Second, and Third temporal, the 
Superior, Middle, and Inferior occipital, and the Island of 
Reil ; these communicate with all parts of the body through 
the Crura cerebri, Optic thalami, Pons varolii, Medulla 
oblongata, and the general nervous system. Among the facul- 
ties which are presumed to emanate from this center, besides 
those already mentioned, are the Emotions, Memory, Im 
agination, Intuition, Reasoning or the power of mental analy- 
sis, Meditation or the production of new thought, Con- 
science, etc. * 

* While considering the elementary functions of life and the parts which unite in 
the performance of each respectively, the conclusions reached hy investigators in em- 
bryology will be of interest as bearing upon this subject. 

The Author when describing the first changes which occur in the ovum of the ver- 
tebrata after ^impregnation says. " The blastoderm at first consists of two layers of 
epithelial cells ; very soon a third layer makes its appearance, between the other two. 
These three layers are known as the germinal layers, and are called respectively the 
Upper, Middle, and Lower layers, or the Epi blast, the Meso blast and the Hypo blast. Of 
these the Epi blast and Hypo blast are primary. 

The Epi blast gives rise to the Epidermis, central and peripheral parts of the ner- 
vous system, and the most important parts of the organs of special sense. The Hypo 
blast is essentially the secretory layer. It furnishes the epithelial lining of the aliment- 
ary canal and its glands, with the exception of partof the mouth and anus, which are lined 
by the Epi blast. * * * the Hypoblast also lines the bronchial tubes and air cells. 
Finally the Meso blast is the source from which the entire vascular system, muscular and 
skeletonal systems and connective tissues are developed. It is more especially to be 
noted that it gives rise to the excretory organs (kidneys and bladder) and the generative 
glands. * * * The cavity of the mouth is lined entirely by the Epi blast from which 
the epithelium and salivary glands are also derived. It also lines the ear and nose. 
—Elements of Embryology. (Loccil.) Foster and Balfour, 1883. 



INDIVIDUAL ORGANS SIMILARLY ENDOWED. 



Passing from the consideration of the organism as a uni- 
to its component parts — if in a broad sense the above classit 
fication is correct, the inference is j ustified that every organ 
in the body must individually possess these various functions. 
This has been verified to a great extent. Even the protoplas- 
mic cell is found to be capable of sensation, of motion, of nu- 
trition, respiration and excretion through osmosis and endos- 
mosis, and of reproduction through its nucleus. This becomes 
more clearly defined as the primary cells of a kind multiply 
and form an organ, then they possess nerves muscles, fibrous 
tissue, blood vessels and lymphatics of their own for the more 
perfect execution of their systemic duty. This being true — 
each organ when diseased, presents the same complicated ques- 
tion met with in constitutional affections, viz: Its sensitiveness 
may be deficient or increased. Its motor power impaired or 
excessive. Its nutrition impoverished or too great. Its cir- 
culation enfeebled or too active ; and its excretory power arres- 
ted or wasteful, etc. 

Thus the problem of disease presents itself primarily in 
two distinct phazes; first as a general constitutional distur- 
bance, which may or may not ultimately involve the integrity 
of some particular organ ; second as an original organic dis- 
order, which at first may not be attended by constitutional 
derangements. Such being the possibilities of a case, it is 



6 INDIVIDUAL ORGANS SIMILARLY ENDOWED. 

important to learn to what extent the sympathetic nervous 
system will reveal the situation. Many cases could be given 
illustrating these different types of disease, the following will 
suffice : 

Syphilitic Iritis— G. W- A. about three months after infec- 
tion began having violent pains in and about the left eye. Examina- 
tion showed a commencing Iritis. These symptoms had been pre- 
ceded for several days by excessive appetite and thirst, pains in the 
back, lassitude and headache. There was also the beginning of a 
papular eruption upon the skin. His temperature was ioi\. pulse 90, 
the urine was high colored and scant. * * * 

Traumatic Erysipelas — A. H. G. was thrown violently to 
the ground from his saddle. The result was a severe contusion of 
the cheek and a dislocated shoulder. The dislocation was quickly 
reduced and the arm gave no further trouble. Upon reaching home 
infiltration and discoloration of the face had developed. His tempera- 
ture was 97 = and pulse 56 with repeated chills. The next day reac- 
tion had occurred. His temperature was ioi c , pulse no and weak, 
he complained of pains in his face which was greatly swollen, and of 
some lameness in the shoulder. Two days later a suspicious redness 
appeared upon the cheek with increased pain and swelling, tempera- 
ture 103°, pulse 120. Considerable thirst was now experienced, the 
urine was scant, no pain in other parts except the face and shoulder. 
These symptoms continued and on the sixth day suppuration was 
discovered, a free incision was followed by a discharge of much gru- 
mous blood and pus. Recovery followed without delay. 

In the case of Iritis it will be observed that the local 
affection had been preceded by disturbance of the organs 
of nutrition shown by thirst and bulimy, also by motor de- 
rangements indicated by backache and weariness: it will also 
be noted that the local affection developed synchronously with 
a general cutaneous disorder. With these constitutional 
conditions preceding and attending, the disease would necess- 
arily develop upon some sensory or cutaneous organ, and 
must be attended by nutritial changes, while it would in- 
volve chiefly the Sensory and Motor apparatus of the affected 
part. 

In the case of Traumatism, it was immediately apparent 
that besides the contusion of the skin, there was considerable 
laceration of the blood vessels and lymphatics, whether the 
malar bone was seriously injured could not be determined. 
When the reflex constitutional symptoms were developed, it 



INDIVIDUAL ORGANS SIMILARLY ENDOWED. 7 

was noticeable that while the cutaneous and circulatory were 
prominent, and nutritial were manifest, the motor phenom- 
ena shown by pains in back and limbs or lassitude did not 
increase, consequently, though inflammation was anticipated, a 
favorable prognosis was given that the bone was uninjured ; 
this was confirmed by the result. 



SYSTEMIC DERANGEMENTS REFLECTED IN KIND UPON 
SPECIAL ORGANS, AND VICE VERSA. 



These cases indicate beyond a reasonable doubt that the 
reflex sympathies between the organism and individual organs 
are complete in both directions. Consequently it may be 
assumed as a general rule, that when a disturbance of one of 
the systemic functions is reflected upon a particular organ, the 
same function will be deranged therein ; and on the contrary, 
if a particular function in an organ is primarily deranged, it 
will ultimately produce the same disturbance in the general 
economy. For example : 

Failure of the organs of Nutrition shown by indigestion or 
mal-assimilation, is followed by arrested development and gen- 
eral atrophy, or by necrosis, or ulceration in some locality ; 
while an excess of normal tissue in a particular organ will 
eventually be attended by disordered digestion. 

A derangement of the Respiratory and Circulatory func- 
tions shown by frequent respirations and a full, hard and rapid 
pulse, as a rule is attended by hyperemia and inflammatory 
stasis in a particular part. And vice versa, a local irritant which 
produces a hemorrhage will, if severe, ultimately induce a 
weak and thin pulse with quickened respirations. 



8 SYSTEMIC DERANGEMENTS REFLECTED, ETC. 

A primary disturbance of the Excretory function indica- 
ted by abnormal urines, will soon be attended by altered 
secretions in some other organ ; or if the derangement begins 
with altered secretions in a remote part, it will presently be 
attended by derangement of the urinary secretion. 

Exhaustion of the Reproductive function shown by am- 
enorrhcea or impotency, predisposes to the development in 
other organs of heterologous tissue — tubercle cancer, etc. Or, 
if such tissue develops primarily in other parts, it is soon in- 
dicated by failure of this systemic function. 

A disturbance of the Motor centers which induces prim- 
arily spasms or paralysis of the voluntary muscles, is likely 
to be reflected upon the involuntary muscles and produce sim- 
ilar or the opposite phenomena therein. Or, an irritant which 
excites local spasms in the respiratory or alimentary tract 
will cause the same or contrary symptoms in the spina] 
apparatus. 

A derangement of the Sensory function shown by general 
hyperesthesia, may be reflected upon an internal organ and 
produce painful conditions, or a loss of normal irritability. On 
the contrary a particular organ may be suffering, and the sys- 
temic function will respond by other sensorial derangements. 

A disorder of the Mental function may be shown by loss 
of sensibility, loss of control over the muscular apparatus, or 
arrested secretions. While if the exciting cause is a distur- 
bance of the corresponding function in a remote organ, it will 
be followed by derangement of the cerebral centres, shown by 
dullness or excitement of mind, coma, etc. 



A. CLASSIFICATION OF SYMPTOMS. 



Webster defines a symptom " as a sign or token which 
indicates the existence of something else." 

In other words morbid symptoms are the product of a 
derangement of two or more organs or functions, and as dis- 
ease is generally manifested by a group of morbid symptoms, 
the analysis of a case requires not only that a diagnosis shall 
be made, but that all the functions involved thereby shall 
be recognized. To do this necessitates the adoption of a uni- 
form plan by which the vast array of symptoms which arise in 
various diseases may be classified and assigned to their re- 
spective organs and functions. 

There are several impediments to such a methodical 
arrangement. One is found in the custom of ascribing reflex 
symptoms to their source. For example, vertigo in one per- 
son is indicative of cerebral disturbance, in another it means 
ocular or auditory derangement, in another it signifies gas- 
tric or cardiac disorder. 

Headache in one case is a sign of brain disease, in another 
it means nervous exhaustion, while in other instances it is 
a symptom of gastric, cardiac, spinal, or uterine irritation, or 
perhaps of toxaemia. 

(Edema in some cases is a cutaneous symptom, in others 
it is indicative of cardiac failure or renal lesions. 



IO A CLASSIFICATION OF SYMPTOMS. 



Spasms are sometimes a symptom of central origin, but 
often they are a sign of enteric, vescical or peripheral irrita- 
tion These and other phenomena indicate that the same 
symptom in different cases, has a different meaning. 

Another hindrance to such an arrangement is the fact 
that the particular symptom is often the product of several 
deranged functions operating together, and it is difficult to 
determine where the symptom belongs. For instance a typi- 
cal case of vomiting is attended by nausea (Sensory), increased 
secretions (Excretory), and excessive peristalsis (Motor); but 
many cases occur in which the only symptom is violent retch- 
ing ; in these the question arises — Is it a disorder of the 
stomach, or of the spinal centres ? 

The usual form of diarrhoea is attended by pain, in- 
creased secretions and spasmodic or involuntary expulsion of 
stools, yet in Asiatic cholera, it sometimes happens that the 
only symptom is, not an increase of normal secretions, but 
frequent and copious serous discharges with a collapsed pulse, 
a condition such as attends a severe hemorrhage ; thus raising 
the query — Should not these cases be considered as diseases 
of the Circulatory rather than of the Digestive organs ? 

In ordinary cases of whooping cough, the respiratory 
apparatus and spinal nervous system are mainly involved, and 
it remains a mooted question whether the disease is a neurosis 
or a Respiratory disorder. 

The usual form of inflammatory rheumatism is charac- 
terized by fever, with heat, redness and swelling of the affected 
joint; but in some cases these symptoms are notably absent '■> 
there is neither heat, redness, or swelling, while the cutaneous 
hyperesthesia and sour sweats are the predominant features. 
Again a question arises : Is this rheumatism ; or some disease 
of the cutaneous envelope ? 

Another bar to the classification of symptoms is found in 
their intrinsic or specific character. This quality, if essential, 



A CLASSIFICATION OF SYMPTOMS. II 

forbids their being classed one with another. A shooting pain 
which characterizes a neuralgic affection, must not be con- 
founded with a burning pain which shows that the mucous 
membrane is affected ; neither with a cutting pain which in- 
dicates the serous membranes, or with a drawing pain which 
denotes the muscular and tendinous tissues. 

Again it has been found that the same symptom occur, 
ring in different individuals is aggravated or relieved under 
different circumstances. In one case the pain is increased by 
exposure to cold or from motion ; in another it is increased by 
eating or sleeping. This being true, the significance of the 
pain is very different in the two cases. 

Passing to concrete forms of disease Herpes, Eczema, 
Lichen, Psoriasis, Scarlet fever, Phagadenic ulcers, etc., are 
different affections and may not be classed together though 
they are diseases of the skin. 

Nasal Catarrh, Laryngitis, Bronchitis, Pleuritis, Pneu- 
monitis and Phthisis, are distinct diseases of the Respiratory 
organs and may not be confounded one with another. 

Dyspepsia, Gastritis, Hepatitis, Enteritis and Typhoid 
fever are quite unlike, though they are affections of the 
Digestive organs. 

Rheumatism, Spasms, Paralysis, Spondylitis and Joint 
affections, are dissimilar, though they are developed in the 
Motor apparatus. 

These impediments appear to be insurmountable, but the 
first and second disappear if the following rule is adopted, 
viz: That every symptom shall be interpreted as belonging 
to the organ or tissue where it appears. Whether it is of reflex 
or local origin will be determined by the order of develop- 
ment of the case. By this rule vertigo, in all cases, will be 
considered as an ocular derangement, and headaches as arising 
from the sensorium, while oedema will be looked upon as a 



A CLASSIFICATION OF SYMPTOMS, 



Cutaneous symptom, and as these several phenomena are shown 
by a group of organs which together constitute the sensory 
apparatus, they must be considered of one common significance, 
indicating a disturbance of the Cutaneous function. By the 
same rule Rheumatism, Spasms, Paralysis and Joint affections 
will physiologically, have but one meaning — a disturbance 
of the Motor apparatus. By this rule fruitless efforts to vomit 
will be a Digestive symptom with spinal phenomena as a 
leading concomitant, and such a form of Asiatic cholera will 
be considered as a disorder of the same class with Circulatory 
phenomena as the chief collateral disturbance, and such a case 
of rheumatism will be considered as a Motor derangement with 
Cutaneous symptoms as the principal attendant. 

The third impediment in some respects is more serious, 
a shooting, burning, cutting or tearing pain is a diagnostic 
symptom and by itself has no place in this study, but when it 
is aggravated or relieved under certain conditions it becomes 
peculiar to the individual. It is upon such as these that the 
main objection to a classification rests. 

It is a question which clinical experience only can deter- 
mine, whether these conditions of aggravation or relief are 
essential as a means of differentiation. There is reason to be- 
lieve that Nature is not so poor in resources as to be thus 
limited in her signals of distress. It is probable that in a 
bronchitis, for example, when the cough is excited by ex- 
posure to cold, by eating and by exercise, that there will be 
found in the case other symptoms of the Skin, Digestive organs 
and Motor apparatus, which would supply the same group of 
indications. It is assumed, therefore, that the particular symp- 
toms in a case are not essential except for diagnosis ; that they 
are unreliable when taken as a guide for the selection of a 
remedy, and that they are of no more value than other symp- 
toms which indicate that a particular organ or function is 
involved. 

The remaining difficulty mentioned, is whether the vari- 



A CLASSIFICATION OF SYMPTOMS 13 

ous diseases which have occurred in the clinical history of a 
patient, should be noted in detail or classed physiologically. 
This is a question, the answer to which depends upon the 
remote results which follow upon diseases of the same class. If 
measles leave a constitutional bias which differs essentially 
from that of scarlet fever, or if gastritis predisposes in one 
direction, and typhoid fever in another, then the elements con- 
stituting a clinical history are important and should be care- 
fully noted in each case. But there is reason to doubt this 
conclusion. Though the immediate sequelae of different 
diseases of the skin or digestive organs may differ, expe- 
rience shows that even in cases where different structural 
changes have ensued, the remote consequences are essen- 
tially one, which is shown by an acquired weakness 
of the entire group of organs belonging to that function ; 
upon occasion, this will be manifested by new symptoms, the 
ocality and nature of which will be determined, by the new 
affection. This being true, a physiological grouping of dis- 
eases is not only justifiable, but necessary. * 

If the main hindrances to a physiological classification of 
symptoms have been considered, it is evidently feasible, and a 
scientific pathology will ultimately require that it shall be accom- 
plished. As this has not been done, any arrangement of the 
different symptoms which is based upon the reciprocal influ- 
ence of the various functions upon each other, must for the 
present b'e tentative and incomplete, meanwhile the following 
tables will serve as a basis for further investigations. 

To facilitate their study the Sensory, Excretory. Motor, 
Mental and Respiratory symptoms in each table should first 
be considered, for when these alone are present in a case, it is 
a functional derangement only. These symptoms being func- 
tional, are also unstable, and within their respective limits may 
change from one organ to another without altering the case. 
These symptoms being functional, may be either of local or 

* An exception to this rule exists in those forms of disease arising from specific causes, 
namely, Tuberculosis. Syphilis, Cancer. 



CATION OF SYMPTOMS. 



reflex origin. When one of these symptoms becomes fixed 
and severe, Circulatory and perhaps Nutritive disorders are 
liable to ensue with more or less structural change in tha* 
part. As long as the 6th and 7th clas- iptoms do not 

attend, the former may be associated together in any manner 
without producing organic lesions. 

Observation seems to prove that Nutritive and Reproduc- 
tive lesions may develop in any organ from direct irritation 
without immediate involvement of the other functions : notably 
tuberculosis or cancer. These cases are however exceptional. 
As a rule nutritive lesions appear as secondary results and are 
preceded by remote disorders of a functional character, the 
most significant of which is circulatory phenomena. Rx 
ment of the circulation and changes in the quality of the blood. 
will, therefore, as a rule, mark the beginning of structural 



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THE ANALYSIS OF A CASE. 



The purpose of these tables is to show the correspond- 
ence existing between the local and reflex symptoms of dis- 
ease. They will be of practical advantage to the physician 
by indicating the various functions involved. For example : 

H. G. VV. was suffering with violent pain in the stomach, nausea 
and frequent retching. Later the retching ceased and was followed 
by frequent paroxysms of colic, with ineffectual urging to stool. 
Finally dysentery was developed, with scant discharges and violent 
tenesmus. His pulse and temperature remained normal. He was 
relieved by hot fomentations, by rest and by sleep. 

As the disturbance was located in the Digestive organs, 
referring to that table these symptoms appeared under the 
Sensory, Motor, Mental and Excretory functions. Turning to 
these tables respectively, the constitutional symptoms of the 
case were found to agree. They were as follows : cold per- 
spiration (Cutaneous), great prostration (Motor), irritability 
and impatience (Mental), and copious urine (Excretory). 

A. N. complained of pain in the knee. There was consid- 
erable swelling, though little heat or redness of the joint. After a 
time the hips, and later the elbows became involved, while the 
knee gave no further trouble. Her pulse and temperature were 
nearly normal. She was worse after eating or sleeping, and was 
relieved in the open air, and by hot applications. 

Upon reference to the table of Motor disorders, these 
symptoms appeared under the Nutritive, Mental, Respiratory, 
Renal and Cutaneous functions. Turning to these tables, the 
constitutional symptoms of the case were found as follows . A 
coated tongue, with constipation (Nutritive), a catarrhal con- 
dition of the bronchia (Respiratory), a tearful and complain- 



34 THE ANALYSIS OF A CASE. 

ing mood (Mental), while the urine was loaded with urates 
(Excretory), and the skin was covered with sour sweats (Cuta- 
neous). 

These cases illustrate the application of these tables to 
functional derangements. The following present a definite 
pathological condition : 

A. G. complained of cutting pains in his chest, difficult respira- 
tion, frequent cough, and copious expectoration, mostly of blood. 
Examination revealed extensive consolidation of the right lung and 
some pleuritic effusion. Respirations 42, temperature 103 20 . 
Cough was aggravated by movement, by eating or drinking and by- 
sleeping. * * * 

Turning to the table of Respiratory disorders, these 
symptoms were found under the Motor, Circulatory, Nutri- 
tive, Cutaneous and Mental functions. Referring to these 
tables, the following constitutional symptoms appeared as 
existing in the case: great prostration (Motor), pulse 136 
(Circulatory), constant thirst and tendency to diarrhoea 
(Nutritive), pallor of countenance and cold feet (Cutaneous), 
apprehensive and fears he will die (Mental). 

H. C. has an incessant cough, with panting, respirations and 
occasional cutting pains in the chest. The 'cough was attended by 
copious expectoration of mucus. Examination shows moderate 
consolidation of the lung, but extensive pleuritic effusion. Pulse 
140, weak. Temperature 104 . The cough is aggravated by 
movement, by cold air and by drinking. It was relieved by stool 
and by urinating. * * * 

Referring to the table of Respiratory disorders, these 
symptoms were found under the Motor, Excretory, Nutritive, 
Cutaneous and Circulatory functions. Turning to these 
tables, the concomitant symptoms of the case were found : 
Constant aching in the lumbar region (Motor), scant red 
urine (Excretory), anorexia and constipation (Nutritive), 
cyanosis (Circulatory and Cutaneous). 

B. T. complained of cutting pains in left chest, difficult respira- 
tion, frequent cough and scant expectoration of bloody mucus. 
Examination showed extensive hepatization of left lung, friction 
sounds in left pleura and scant exudation, temperature 102 . The 
cough was aggravated by movement, by drinking and by mental 
application. The pains were relieved by heat and by short respira- 
tions. * * * 



THE ANALYSIS OF A CASE 35 

Turning to the table of Respiratory disorders, these 
symptoms indicated that besides the lung and pleura, the Cir- 
culatory, the Motor, the Nutritive, the Mental and the Cuta- 
neous functions were involved. Referring to these respect- 
ively, the concomitant symptoms of the case were present. 
Pulse 90 (Circulatory), rheumatic pains in back and limbs 
(Motor), occasional delirium (Mental), thirst and diarrhoea 
(Nutritive), with flushing of face during cough (Cutaneous). a 

M. W. had an incessant cough with a catching pain in the left 
side. Respirations 36, scant expectoration of bloody mucus. 
Temperature 104 . Examination revealed friction sounds and 
hepatization of lower third of left lung. There was aggravation 
from cold air, from exercise, from fasting and from want of sleep. 
* * * 

The table of Respiratory affections, in this instance 
showed that the Nutritive, Cutaneous, Mental and Motor 
functions were involved. The concomitant symptoms of the 
case corresponded in every particular. There was frequent 
thirst and constipation (Nutritive), chills alternating with 
flashes of heat (Cutaneous), anxiety and apprehension 
(Mental), and much restlessness (Motor). 



THE RELATIVE IMPORTANCE OF SYMPTOMS. 

Having learned the group of functions disturbed in a 
given case, a further study becomes necessary. Taking the 
last one as an example, there might be many pneumonias 
which would involve the same functions and present the same 
group of symptoms, yet they would differ one from another in 
the relative severity and importance of the collateral symp- 
toms. In one the gastric and spinal might predominate, in 
another the gastric and cutaneous, while in another the gas- 
tric and mental would be most prominent. Again, in 
another, the cutaneous would be most severe with mental 



36 RELATIVE IMPORTANCE OF SYMPTOMS. 

second, or the cutaneous with spinal second, or the cutaneous 
with gastric second. The same variation might be traced in 
the severity of the other collateral phenomena, consequently 
there might be a great number of cases in which the same 
functions were involved, yet they would be unlike, not only in 
their probable results, but in their therapeutic requirements. 

In any pathological condition, there are to be found both 
subjective and objective symptoms. As a rule the former are 
productive of much suffering, and to the patient, are of the 
greatest importance, while the latter, if recognised, are to 
him of no consequence. To the physician, however, their im- 
portance is often reversed, for he knows that the objective 
symptoms frequently indicate the gravity of the case, and 
prove to be the guiding indications for treatment ; conse- 
quently some rule must be adopted by which the relative im- 
portance of the various symptoms can be learned with cer- 
tainty. 

It is an axiom in therapeutics that the cure of disease is 
dependent upon removal of the cause, or what represents the 
cause. Whether the cause is single or multiple, remote or 
near : whether its origin is in hereditary or acquired weak- 
nesses, it must find expression in the order of development of 
the acute disease, and in the relative severity and importance 
of the attending symptoms. 

In chronic affections, it seems probable that hereditary 
weaknesses will determine, in large measure, the sequence of 
diseases that will occur in the life history of the individual ; 
and as the drift of the case becomes manifest, it will thereby 
indicate the path by which the end will be reached. 

The first case of pneumonia described, occurred in a 
man who had suffered with dyspepsia, at intervals, for many 
years. For several days he had complained of flatulency, loss 
of appetite, and wandering pains in his chest. After ex- 
posure he was taken with a chill, followed by heat, thirst, 
increased pains and a slight hemorrhage from the lungs ; 



RELATIVE IMPORTANCE OF SYMPTOMS. T>7 

pleuritic symptoms presently ensued, with aching pains be- 
tween the shoulders, and much prostration. In this case the 
disease began with derangement of the organs of Nutrition, 
soon attended by pulmonary symptoms. Then occurred a 
chill, and other Cutaneous phenomena, followed by pleuritic 

and other Motor derangements. This being the order of de- 
cs o 

velopment, the symptoms of the Digestive organs were most 
important, as representing the origin of the case. Those 
of the Lungs and Pleura were second in importance while 
the Cutaneous, Spinal and Mental, were of comparatively 
little consequence. 

In the second case, the pneumonia had followed after an 
attack of measles. It developed as the eruption subsided. 
After the cough had become painful, the appetite failed, 
while debility increased — and the urine became insufficient. 
This being the order of development, the Cutaneous were 
more important than the lung symptoms, while the Digestive, 
Motor and Kenal phenomena were of subordinate importance, 
though they served to give character to the case. 

The third case occurred in a man, who, for many years 
had been subject to gastric and hepatic derangements. Ten 
years previous to this sickness, he had rheumatic fever, 
which had been twice repeated ; on the last occasion, one 
year ago, there was metastasis to the brain ; since then he 
has been subject to violent headaches. For several days pre- 
vious to the present illness he had a coated tongue, loss of 
appetite and constipation, soon attended by lassitude and 
headache ; he feared another attack of rheumatic fever. 
After exposure in a storm, he had a chill, with stitching 
pains in his side and a dry, irritative cough. In this instance, 
the order of development began with disturbance of the 
organs of Nutrition, succeeded by Motor derangements, later 
appeared Mental, followed by Cutaneous symptoms. Then 
the pneumonia became manifest, consequently, as these vari- 
ous disorders had preceded, they, in the order of their occur- 



38 



RELATIVE IMPORTANCE OF SYMPTOMS. 



rence, were of more importance than the local symptoms, as 
indications for treatment. 

The fourth case occurred in a young woman, who after 
"becoming heated had resorted to an open window. Suddenly 
a chill occurred, presently attended by nausea and vomiting ; 
after half an hour, fever heats developed with cough and 
pains in her lungs ; these symptoms rapidly increased, ac- 
companied by pains in the back and limbs ; that night she 
slept but little. In this case the chill indicated the first dis- 
turbance of the economy; then followed gastric symptoms ; 
presently fever heats developed with the beginning of the 
local affection. Thus the Cutaneous and Digestive symptoms 
were more important than those of the lungs, while the Motor 
and Mental disturbances served to further modify the case. 



THE CLINICAL HISTORY IN CHRONIC DISEASES. 



A Case Terminating in Phthisis Fulmonalis. 



Lucy C. had a double inheritance of tuberculosis. When three 
months of age she developed a severe form of eczema which per- 
sisted for more than a year ; during this time she had a voracious 
appetite, became very fleshy and grew rapidly, though she was in- 
dolent and did not exhibit the normal activity of infancy. When 
nine months of age, her mother applied zinc ointment, and in a few 
days her scalp and face were much improved. Soon after she 
lost her appetite and gradually developed diarrhoea, notwithstand- 
ing the use of the ointment was discontinued, the diarrhoea 
persisted and at one time became serious. Finally the eruption 
reappeared and the diarrhoea ceased, leaving the child consti- 
pated. Two months later the eruption again healed, this time 
without apparent cause, and there ensued a dysentery. After that 
had ceased the child grew rapidly and seemed well, except that 
when two-and-a-half years of age she was still indisposed to walk. 
At four years, a lateral curvature of the spine developed to a mod- 
erate degree, with decided impairment of physical strength. At 
seven years she passed safely through the Scarlet fever and Meas- 
les, the latter was severe, and left her permanently deaf from catarrh. 
From her eighth to her thirteenth year, her health seemed good, 
though she took cold easily from exposure, and had cold or moist 
hands and feet at all times. Whenever she took cold an attack of 
diarrhoea or an aggravation of the nasal catarrh would ensue, 
sometimes attended by cough. Menstruation was established at 
thirteen, and was at all times premature and excessive, so much 
so as to keep her thin and debilitated. She married at eighteen, 
and had a child or miscarriage every year thereafter until she was 
twenty four years of age. At that time she "took cold " and began 
having night sweats, without apparent cause. Soon her appetite 
failed, she became anaemic and weak ; later a cough developed and 
menstruation ceased. From this time the progress fof the disease 
was rapid, emaciation and diarrhoea ensued, and six months later 
she died of Phthisis. 



40 CLINICAL HISTORY OF CHRONIC CASES. 

A Case Terminating in Bright's Disease. 

Hattie A. vet. 19. Father died of cholera, Mother of dropsy. 
From birth she had artificial feeding and much difficulty was experi- 
enced in finding suitable foods. Cholera infantum occurred 
when six months of age. After this her digestion continued poor, 
and she remained thin in flesh, though growing rapidly. During her 
third year she had scarlet fever severely, followed by rheumatism, 
which persisted for some time. At the age of seven she had whoop- 
ing cough, which continued through the winter. Following this, 
witn the exception of dyspepsia, her health was fair until her four- 
teenth year, then occurred typhoid fever, which left valvular heart 
lesions. After this her health was never good, nutrition was poor 
and she remained pale, weak and nervous. Slight, but ineffectual 
attempts at menstruation were manifested at irregular intervals ; 
she took cold easily, and was liable to have a cough that was 
difficult to allay. 

This case came under observation about two years since, 
when, after unusual exposure and fatigue, she exhibited general 
anasarca, with suppression of urine. Attending there was a debil- 
itating diarrhoea, with much thirst, high fever, acute pains in back 
and limbs, and pulse weak and rapid. Upon examination, the scant 
urine was found to be heavily loaded with albumin, and tube casts 
were numerous. Suitable treatment was followed by recovery on 
this, and on a subsequent occasion, but in a third attack of the 
same nature, which occurred during an attempt at menstruation, 
uraemic coma ensued, from which she never recovered. 



In reviewing the first case, it will be observed that with 
the eczema, there existed from the beginning, derangement, if 
not disease, of the digestive organs and motor centres, shown 
by abnormal appetites and deficient vigor. With disappear- 
ance of the eruption this weakness became more apparent in 
diarrhoea. These symptoms finally subsided, but the weak- 
ness continued, showing itself in innutrition, retarded develop- 
ment of bone, and spinal curvature. After a period of health, 
the original weakness again appeared in scarlet fever and 
measles, the latter being followed by a new affection, catarrh 
of the air passages. Another period of comparative health 
ensued, but there is evidence showing that the Cutaneous, 
Digestive and Respiratory functions continued to be weak. 
Menstruation then became established, and from the first was 
abnormal. Thus, with five of the vital functions permanently 
disabled, marriage and frequent pregnancy ensued. It is 



CLINICAL HISTORY OF CHRONIC CASES. 41 

not strange that an organism thus handicapped should break 
down under this additional strain. Neither is it surprising 
that when the end came, it should be foreshadowed through 
those organs and functions that were primarily and most 
seriously involved — namely the Cutaneous, the Digestive, the 
Motor, the Respiratory and the Reproductive apparatus. 

In the case which ended with Bright' s disease, from the 
first there was evidence of weak digestive powers and defi- 
cient nutrition. After an interval there occurred scarlet 
fever, rheumatism and whooping cough. Whether or not 
these affections left a permanent weakness, cannot be deter- 
mined. Later, typhoid fever was experienced, a renewed dis- 
turbance of the alimentary tract, and a heart lesion ensued, 
then it became apparent that the Cutaneous, Spinal and Res- 
piratory functions previously involved, had been permanently 
weakened, so seriously indeed, that they prevented menstrua- 
tion from being established. These conditions of impairment 
continued until acute nephritis occurred. This under ordi- 
nary circumstances would have been easily remedied ; but com- 
ing in addition to other infirmities, it was necessarily fatal. 



43 



CONCLUSION. 

If these observations are true, they point to several con- 
clusions : 

First — That hereditary weaknesses manifest themselves in 
the peculiar sequence of diseases which occur in the 
life of the offspring. 

Second — That each acute disease, occurring in the life of an 
individual, is a unit, the sum of which will find ex- 
pression in every subsequent disorder, whether acute 
or chronic. 

Third — That in the beginning of acute diseases, the order in 
which the various bodily functions are disturbed, will 
indicate the importance of the respective symptoms. 

Fourth — That the functional disorders preceding the develop- 
ment of a local lesion, indicate the causes of the dis- 
ease ; consequently they are of more importance as 
indications for treatment than the lesion itself. 

Fifth — That the order of development of an acute disease will 
correspond to the pathological sequence found in the 
clinical history of the case. 



Sixth — As every disease has many methods of development, 
and the method of each individual is common to all 
diseases that may affect him — it follows that a knowl- 
edge of the personal element in each case, as shown 
by his clinical history, is of more importance to the 
therapeutist, than is a diagnosis of the disease. 

It is probable that exceptions to rules five and six will be 
found in alien diseases, especially the great epidemics, le 



44 n :lusion. 

Grippe. Asiatic cholera. Yellow fever, etc.: likewise in severe 
infections, such as Syphilis, Hydrophobia, etc., as each of 
these have an order of development peculiar to themselves, 
which proves to be much the same in all cases, whatever mav 
be their clinical history. 

While further observations may change these conclusions, 
the principle involved must abide : this idea is not new : the 
modifying influence of the clinical history has long been rec- 
ognized. What remains is to establish a physiological con- 
nection between past events and present phenomena, and 
eliminate chance as a possible element in any case. 

Accepting these observations as indicating a law govern- 
ing the devolution of life, the object desired is to arrest this 
process : to do this intelligently, a different knowledge than 
now exists must obtain concerning the effects of medicinal 
agents upon the living organism. 

As a basis for further observation, the following principle 
may be considered as proved by clinical experience, namely : 
That there is a natural antagonism between the force inherent 
in drugs and the vital force : by which, when administered in 
health, the former will produce an artificial disease ; and if 
given in sickness, will restore health, or modify the course of 
the disorder. Hence Astringents are useful in fluxes ; Tonics 
in debility : Anaesthetics in pain : Antipyretics in fever : 
Sedatives in mental excitement, convulsions, etc. But the 
success of this principle is limited if the drug is given solely 
because it is antagonistic to the chief disorder : not every 
astringent is beneficial in a particular flux, or any tonic in a 
special case of debility ; neither is antipyrine useful in all 
fevers, consequently a special adaptation is required of a 
particular remedy to each case. This indicates that the 
efficacy of the remedy is dependent upon some other relation, 
and this must be ascertained before an accurate therapeutics 
becomes possible. 



conclusion. 45 

As contributing to a knowledge of this relation, the 
following pathogenetic facts are submitted as being capable of 
proof; referring to the Cyclopaedia of Drug Pathogenesy, it 
will be found that if a drug is given singly, in medicinal doses, 
it will produce, in healthy persons, a succession of symptoms 
arising sooner or later from every function of the body. And 
though the symptoms in different persons may differ in char- 
acter and location, if interpreted by the above tables, the 
sequence indicated thereby will be the same in a majority 
of cases — and, so far as observed, it is peculiar to that drug 
alone. 

The same authority reports cases of poisoning, which 
show that the immediate effects produced by one of these 
drugs, is to produce a group of functional derangements that 
corresponds in every feature, with the sequence obtained from 
medicinal doses of the same agent. 

The same record gives cases of chronic poisoning by 
certain drugs, in which a series of distinct organic diseases 
developed, one after another, in different parts of the body ; 
and while these differed in name in different cases, the 
parts involved were the same in each ; and the sequence 
produced corresponded in function with that obtained from 
medicinal doses of the same remedy. 

From other sources, cases have been gathered, which 
show that when one of these drugs has been given to the sick, 
in medicinal doses, and its sequence did not correspond to the 
case, it temporarily produced its own group of symptoms, 
without relieving those already present. 

Finally as indicating the practical bearing of this subject 
upon therapeutics, many cases have been reported, by mem- 
bers of both schools of practice, where these drugs were given 
with favorable results ; and in every instance, the group 
of derangements described in the case, was similar to the 
group of functional disorders which are characteristic of the 
remedy. 



46 CONCLUSION. 

Experience in our College clinic indicates further, that 
the custom of adapting a remedy directly to the disease, is a 
mistake. Better results are obtained in acute disorders, when 
the indications for treatment are sought in the order of devel- 
opment, or the collateral symptoms of the case. 

In chronic affections, the sequence shown by the clinical 
history of the patient, prior to the development of the present 
disease, has proved to be the best guide to the selection of the 
remedy. When this pathological sequence is met by a drug 
that is capable of producing a similar sequence, improvement 
begins at once. This is often shown by a decline of the 
present, and a return of former complaints. 

If these statements can be corroborated, they prove that 
the successful use of drugs as therapeutic agents, is dependent 
upon both rules of practice being observed. A remedy acts 
curatively by the rule of Contrariety provided it is selected by 
the rule of Similia, then it can antagonize the disease at 
every point. If this is true, it remains for the practitioner to 
learn the personality of each case, and the individuality of 
each remedial agent ; then the homoeopathic remedy can be 
adapted to the sick, in the majority of cases, with satisfactory 
results. 



CONTENTS 



The practical difference between the two Schools of Medicine, 

Hahnemann's conception of the " Similia " incomplete, 

His Materia Medica inadequate, 

The instability of symptoms in disease, 

The unchangeable features of a case, 

A new study of physiology indispensable. 



PAGE 

iii 
iv 
v 
vii 
viii 
x 



The Systemic Functions and their organs, 
Individual organs similarly endowed, 
The reciprocal influence of the organs and organism, 
A Classification of symptoms, - - . 

Table showing symptoms of the Cutaneous function, 

Table 

Table 

Table 

Table 

Table 

Table 

Table 

The analysis of a case 

The relati re mportance of Symptoms, 

The influence of the Clinical history, 

Conclusion, - 

Items concerning Pharmacodynamics and Therapeutics, 



Respiratory function, 
Circulatory function, 
Nutritive function. 
Urinary function, 
Reproductive function, 
Motor function, 
Mental function, 



i 

5 
7 

9 

17 
19 

21 
23 

25 

27 
29 
3i 
33 
35 
39 
43 

45 



